What causes symptoms suggestive of tuberculosis in HIV-positive people with negative initial investigations?

Autor:	Hanifa Y; TB Centre, London School of Hygiene & Tropical Medicine, London, UK., Toro Silva S; TB Centre, London School of Hygiene & Tropical Medicine, London, UK., Karstaedt A; Department of Medicine, Chris Hani Baragwanath Hospital, Johannesburg, University of the Witwatersrand, Johannesburg., Sahid F; Department of Medicine, Chris Hani Baragwanath Hospital, Johannesburg, University of the Witwatersrand, Johannesburg., Charalambous S; The Aurum Institute, Johannesburg, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg., Chihota VN; The Aurum Institute, Johannesburg, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg., Churchyard GJ; TB Centre, London School of Hygiene & Tropical Medicine, London, UK, The Aurum Institute, Johannesburg, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Advancing Care and Treatment for TB-HIV, South African Medical Research Council Collaborating Centre for HIV and TB, Tygerberg., von Gottberg A; Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg., McCarthy K; The Aurum Institute, Johannesburg., Nicol MP; Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, National Health Laboratory Service, Johannesburg., Ndlovu NT; The Aurum Institute, Johannesburg., Stevens W; National Health Laboratory Service, Johannesburg, Department of Molecular Medicine and Haematology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg., Fielding KL; TB Centre, London School of Hygiene & Tropical Medicine, London, UK., Grant AD; TB Centre, London School of Hygiene & Tropical Medicine, London, UK, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Africa Health Research Institute, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
Jazyk:	angličtina
Zdroj:	The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease [Int J Tuberc Lung Dis] 2019 Feb 01; Vol. 23 (2), pp. 157-165. Date of Electronic Publication: 2019 Jan 24.
DOI:	10.5588/ijtld.18.0251
Abstrakt:	Objective: To identify the causes of symptoms suggestive of tuberculosis (TB) among people living with the human immunodeficiency virus (PLHIV) in South Africa. Methods: A consecutive sample of HIV clinic attendees with symptoms suggestive of TB (1 of cough, weight loss, fever or night sweats) at enrolment and at 3 months, and negative initial TB investigations, were systematically evaluated with standard protocols and diagnoses assigned using standard criteria. TB was 'confirmed' if Mycobacterium tuberculosis was identified within 6 months of enrolment, and 'clinical' if treatment started without microbiological confirmation. Results: Among 103 participants, 50/103 were pre-antiretroviral therapy (ART) and 53/103 were on ART; respectively 68% vs. 79% were female; the median age was 35 vs. 45 years; the median CD4 count was 311 vs. 508 cells/mm³. Seventy-two (70%) had 5% measured weight loss and 50 (49%) had cough. The most common final diagnoses were weight loss due to severe food insecurity ( n = 20, 19%), TB ( n = 14, 14%: confirmed n = 7; clinical n = 7), other respiratory tract infection ( n = 14, 14%) and post-TB lung disease ( n = 9, 9%). The basis for TB diagnosis was imaging ( n = 7), bacteriological confirmation from sputum ( n = 4), histology, lumbar puncture and other ( n = 1 each). Conclusion: PLHIV with persistent TB symptoms require further evaluation for TB using all available modalities, and for food insecurity in those with weight loss.
Databáze:	MEDLINE
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